Monday, April 26, 2010

I'm a doctor. We get all the glory. And credit. And guess what? We only deserve part of it.

I started out in medicine in the mid-80's, volunteering at an ER. And the biggest shock to me was learning how much of what happens in a hospital is nurse territory. Us doctors will see you from 5-30 minutes a day (30 is A LOT), depending on how sick you are. And the rest is the nurses.

They come in all shapes, colors, and sexes. Yes, there are a few idiots out there, that I take shots at in this blog. And there are idiot doctors, too. Idiots are in all fields, but the majority of nurses are damn good.

They're the ones making sure you get your pills, checking that your vital signs aren't dropping (and doing what they can to save your ass initially if they are, of which calling a doctor is only one part). They make sure you don't fall down and break something. If you start barfing, us doctors will run out of the room and the nurses will rush in. They change your wound dressings and start your IV line. They'll bring you a warm blanket. And clean disgusting things off you. Even if you're drunk. Or delerious. Or mean. And through all of this they try be friendly and positive. Even though you aren't their only sick patient.

I respect nurses A LOT. I learned early on that they're key to being a good doctor. You piss off the nursing staff, and you'll have a miserable career at that hospital. Respect and treat them well, and you'll never regret it. They're as important to being a good doctor as your medical degree. Maybe more.

If you come out of medical school with a chip on your shoulder against nurses, you better lose it fast. Because they will make or break your training, and often know more than you do. Be nice and they'll teach you. A good neuro nurse is often a better inpatient neurologist than some doctors I've met.

I remember a guy named Steve, who was an intern with me a long time ago. He had his head up his ass about being a doctor, and saw nurses as lesser scum. We were only a few months out of med school, and as we were writing chart notes one morning a nurse came over and asked if he'd go listen to his patient's heart. With icy contempt, and not even looking up from the chart, he said "I don't have to listen to his heart, because I looked at his EKG." They ain't the same thing, dude. If he'd listened he might have noticed that the patient had developed a loud murmer in the last 24 hours. When the attending caught it a few hours later, Steve got his ass chewed out. If he'd taken the nurse's advice, and listened, he wouldn't have gotten reprimanded by the residency board.

I talk about my Bible a great deal in this blog. Here's a quote from it: "Working with a good nurse is one of the great joys of being a doctor. I cannot understand physicians who adopt an adversarial relationship with nurses. They are depriving themselves of an education in hospital wisdom."

Those doctors are also depriving themselves of friends. On a shitty day on call, sometimes all it takes is a sympathetic nurse to temporarily add you to her patient list, steal you a Diet Coke from the fridge, and let you cry on her shoulder for 5 minutes. It doesn't make the day any less busy, but helps you absorb the punishment better.

What got me started on this?

While I was rounding this weekend, a grateful patient's family brought the ICU nurses a box of donuts, and so the staff was picking through them. One said "Oh, this kind is my favorite, it has cream filling."

And some pig in one of the rooms yelled "Hey, babe, I got my own kind of cream-filled dessert in here! Come have a taste!"

You say that to a waitress, and you'd likely get your ass kicked out of the restaurant.

You say that to a co-worker, and you'd be fired and/or sued for harassment.

You say that to a lady in a bar, and you'll likely get a black eye.

And what did the nurse do? In spite of the fact that the guy was obviously a detestable jackass, she went in his room, turned off his beeping IV pump, and calmly told him that he would not talk to her that way.

And I admire the hell out of that.

Nursing is a damn tough job. And the people who do it are tougher. And somehow still remain saints.

While this post isn't about them, there are a lot of other unsung heroes who are part of the hospital team- pharmacists, social workers, nursing assistants, EMT's, respiratory therapists, X-ray techs, lab techs, physical/occupational/speech therapists, housekeeping staff. And many more.

Now that should be part of the compulsory core curriculum. Lovely post. As you say though, head up arse disease does not discriminate based on profession

I found that the interns were often the biggest arses. I still remember being chewed out in front of other staff and patients for daring to suggest to the ward intern that a confused patient had suffered a stroke. I was informed that a lowly neuropsych can't spot neglect, and I had no idea what I was talking about and was wasting his time. Luckily I ran into the consultant, he order an MRI and lo and behold what did he find, one big arse bleed. Luckily the NUM had also seen the display and the intern in question soon realised that we lesser staff tend to take care of our own and that politeness is a useful medical skill.

Nice. And, I agree...nurses are great. Last year my son was in the hospital with bacterial meningitis. Nobody knew if he was going to live or die. One particular nurse, a male nurse, which seems unusual, was great. We got there late, and he acted like we were the only people on the floor even though it was filled to capacity with sick kids. He made jokes, and put up with my bitching about the annoying beeping IV pump that was driving me nuts. My son, of course, didn't hear it because he had no hearing. Bacterial meningitis is evil like that. He got me a toothbrush, told me where I could find soda, and gave me a list of all the delivery places that would deliver tolerable food to the hospital. I was sad when, after 2 days, he had the rest of the week off! I missed him! He was great when he was there because he listened to me complain about all the doctors who weren't giving me any information. ;) If it weren't for him I might have strangled a resident! Geeez. A teaching hospital and most everyone there looked like a kid to me, and everyone was getting on my nerves. In my defense, though, I didn't know if my 7 year old son was going to make it and was rather stressed.

For the record, my son is fine. One week in the hospital, 3 weeks of IV infusions every 3 hours (I didn't sleep for a month, but learned how to give my son IV infusions through a picc line! I now know more about medical stuff than I ever thought I would!), and a cochlear implant later, and you can't even tell he was ever sick. :-) Yea!

Anyway, I just strayed from my point. The point was, yeah...nurses are cool. :)

That post means a lot. I am an NP (and former floor nurse) and the tables were turned last year when I was in 2 hospitals for 3 weeks. It became SO apparent how awesome nurses can be AND how a team of doctors that get along with their nurses and NPs works SOOO much better together. I love your humor on this blog, but today's post, even if it was serious, was by far one of the best posts I've read.

I can also attest to the wonders of nurses. My second son was born with a defect in the skin on his scalp. The OB and pediatric resident checked him, gave us a list of scary possibilities, and then told me I'd have to wait for more info until the neonatologist came in the next morning (this was about 8PM). My L&D nurse, on the other hand, went to the library at the hospital after her shift was up and came back to my room at 3AM (we were awake and distressed, needless to say) with a pile of reassuring printouts and a hug. Bless her for the angel that she is.

I used to work night shifts in a busy hospital; 'no man's land' where we were busier than heck but always 'nothing' to the day shift staff within my professional department.

Inside my job I had the loveliest resting place in my nurses, x-ray and lab techs, late-rounding docs, and the folks that ran the kitchen. And, those few docs on call during nights that could manage two words in a row. Those sweet nurses (and, every single one on nights was except those that couldn't hack nights and gave bad attitude) were truly the only people I missed when I left night shifts.

Hey thanks, Grump!! When my son was a first-year resident doing an ER rotation, he got a little too full of himself as "the doctor", bitching about nurses (of whom I am one, with 30+ yrs. under my scrubs). I sat him down and gave him "the talk", and warned him that some day, one of those lowly nurses could just save his ass, and suggested that he find a few he trusted and respected and cultivate a good working relationship with them. A few months later, he confessed that one such nurse had indeed pulled his butt out of the fire one night and thanked me for the advice. He now goes out of his way to stay in good graces of the nurses who are truly on the front lines of patient care.

Raise your hand if you've ever caught an impending herniation early and prevented a patient's death.

*Raises hand*

Raise your hand if you've ever noted just a few drops of spinal fluid coming from a spinal surgery patient's incision and called the surgeon before that sh*t got outta hand....blah blah blah, the list goes on.

Though my surgeon was great, when I got my ICD it was a respiratory therapist who held a cold cloth to my head and let me squeeze the hell out of her hand during the half hour it took to dig around and get an arterial line started (which must have driven them as crazy as it did me). She's the one I remember most.

Just chipping in to say that I 100% agree. I saw somebody make a comment on SDN recently where their signature was... well, I don't exactly remember, but something about nurses not being able to pass some test that all doctors can pass post-call. Made me incredibly angry. I have the utmost respect for nurses and all the ancillary staff.... sometimes I fear them a little, but I always respect them! :)

I admit I've had the pleasure of working with many physicians with just your attitude & it does make this huge wheel of medicine run smoother. They've each one thanked me & I them at one time or another.

Thank you kind sir & thanks to all the nurses who don't yell at me when I'm a bit late with their meds. Why rarely matters, its how we deal with the end result that does.

Amen to this.I will never forget the nurse who helped me after our first child was born. After a great birth, I later passed out and hit my head. My son started screaming and wouldn't nurse and I hadn't even really had a chance to get cleaned up. A nurse came in and made me feel like it was the best part of her day to help me get a shower. She gave me back my dignity. She knew how to calm the screaming baby and predicted (accurately) that after a wild newborn period, we'd have an incredible boy on our hands. Her name is Nicole and I was way too out of it to thank her properly at the time, but I sent a nice letter a few weeks later.

I've encountered a lot of nurses in the course of my chronic pain & soon to be 9 surgeries on my knees (and one other surgery & two procedures &&&). My pcp also has two nps in her office who shine like the stars they are. I adore the 'good' nurses. They make me feel less scared if I'm scared, cared for, comforted, and just all around less worried about everything.

The 'bad' nurses, the ones that have become to see patients as bodies they have to interact with to get their paycheck. The ones who would really rather be elsewhere. I loathe & despise them. They make me want to leave the hospital before I should. My stomach churns each time they come to my room and I have tears in my eyes should I need to hit the call button.

Why? Because they just don't care. They'll often take 10 - 30 minutes to get to me when it's a call that requires immediate attention and then come in with a surly attitude because I dared to ask for help. OTOH good nurses come swiftly with a smile on their faces and do their best to make sure that what I need is done in the kindest way to prevent causing more pain. I adore good nurses and try to make their job easier. Bad nurses? I could care less about them.

Dr Grumpy - you brought tears to my eyes! Thank you! I think I am going to post your post on my locker.Marisapan - LOVE the bumper sticker!Anon - hope you dont mind if I steal your reponse to 'eat shit' but it was beyond perfect!

In addition to working the floors, I am also a clinical instructor. It is a sad thing to say, but in the past 2 - 3 years I have seen more students coming in for secure jobs/good paychecks rather than for their heart. And you cant be a good nurse if you dont have nursing in your heart. Those nurses are the ones you can pick out easily - and so many of the above postings have shown what makes a nurse with nursing in her heart.

I have always taught my children not to mess with people who carry weapons - and nurses have always been #1 on that list! LOL

An average nurse is worth their weight in gold. An excellent nurse is worth their weight in platinum.

A bad nurse is worse than terrifying. Fortunately, bad nurses are far, far, FAR more rare than bad doctors.

Almost every nurse I've ever dealt with has been beyond awesome. It didn't matter if I was barfing up a lung, freezing from fever chills, or just medicine time, they've always made my suffering that much easier.

I hope I've always been able to thank the nurses enough. The one time I was neutropenic and my well meaning but nitwit coworkers sent me a big basket of fruit I gave it to the nurses.

I am very proud of my husband's work as a hospice nurse. That has to be one of the toughest nursing jobs out there. he is walking into the end of someone's life and has to extend extraordinary amounts of grace and compassion to the patient as well as the family who may be full of grief or just being difficult. My hats are off to all medical personnel.

Dr. G...let me add to the chorus of thank-you's! Nice to be appreciated.

And as the wise doc points out, you babydocs need to listen to nurses. Otherwise, you might get paged every time you are on call for Tylenol orders---exactly 45 minutes after a delivery, so you are Juuussstttt getting to sleep! Crude but effective resident training tool!

As an RN I have been bitten, kicked, slapped, clawed, spit at, screamed at, barfed on, bled on, shit on, pissed on. I've had a full jug of juice thrown at me and been threatened with a pair of scissors.

I can't even really be angry about most of it because 99% of the time the patients couldn't control it (due to brain injuries, psychosis, Alzheimer, fear, etc.) but it still adds up to a challenging day at the 'office' sometimes.

And there were days when I was so exhausted I couldn't even cry at the end of a shift.

But there is something unbelievably unique and wonderful about the role a nurse has and that is what got me out the door and into the ED with a smile on my face for almost every shift.

Three years ago, I took my wife who had spent the night throwing up with the flu to the ER to get rehydrated. Turned out that meningococcal bacteria was in her bloodstream and she was on her way to septic shock. The ER doc got her to the ICU very quickly. But, maybe 12 hours later I was trying to decide whether or not to continue life support. The doctor -- who had come on in the ICU a few hours before at midnight -- was saying this was always fatal. Our two boys and her siblings were in shock, looking to me. I went into her room -- where the ventilator pumped her body bloated from the fluids that were giving her some blood pressure -- and had a long talk with the person I trusted the most that night -- her nurse. When my wife died an hour or so later, she was the one person on staff who gave me a long, compassionate hug. Nurses are wonderful.

Thanks, Grumpy. It's doctors like you who make up for the doctors who treat us like dirt. And if you develop a reputation for not treating the nursing staff well, that news will spread faster than wildfire.

There's nothing like an experienced nurse who knows exactly what you're going to feel before you do, and knows exactly how to make it better.Anyone who works in medicine and doesn't respect the nurses is in for a rough time. And the good docs always know it!

Grumpy--you're THE man,er,....the Dr.!! Have worked with fabulous docs and some real slimes..and seems you learned the magic lesson early. Respect on both sides can work miracles for patients! Thanks. CP

thank you dr grumpy. the nurses i had when i was in the hospital twice in the last year (apparently i'm allergic to insulin) were top notch. i know what top notch nursing is, its what my granny did. and my aunt did. and my mama did.

(granny is a legend for telling evel kinevel he was an idiot after he had that huge wreck in the astrodome. he requested her as his nurse after that. hee!)

and the nurse who called me from the hospice ward to tell me that my beloved fal had indeed gone away and the cancer wasnt tormenting him any longer, is solid platinum to me. she didnt call the funeral home till i could get there (2 am. christmas morning. three years ago last year.) and gave me a long hug when i asked for it.

thank you doctor grumpy. for realizing how much nurses do, and giving them credit for it, and respecting their place in the medical hierarchy.

I never could understand how someone felt they were entitled to serve up a ration of crap to a nurse, a corpsman or even an intern.Wasn't for them I'd be worm chow and I treasure the memories of the funny, charming, sometimes bizarre and extremely competent people who have kept my old bones above ground through the years.God bless each and every one.

Your post meant alot to me too. Mymom was a nurse and there were alotof stories regarding, docs with thechip on the shoulder. I too experienced it first hand. When my son was 6 wks old he was hospitalized for a fever of unknown origin. When I took his temp it was as high as 105. This really freaked a first time mom. I stayed in the hospital with him while they ran tests. He was ontylenol which was soso with thetemp. As an aside, don't know why but I could always get close to thetemp amount with a kiss to forheadprior to taking his temp. On his 2nd day there a nurse was in to take vitals, and it was 99. An hour later a doctor came in fora check. As I rocked him momentsprior I felt his temp was back upto 105, after said kiss. Before I could alert nurses, in comes in doc. I tell him this and he says it was just checked and he was fine. I asked to have it checked again, he said no. When he left I asked the nurse. His temp was 104.9. Hours later we found outhe had sepsis(?) from an ear infection. The nurses were angels.Even if they just checked his temp,if I asked, they would immed. do it. One weird post script, Neversaw that doc again. A week laterhe was released. Bravo to allnurses!

Wow!I love your post about nurses! True, nurses are workers who work harder than doctors and if doctors didn't treat nurses well they'll soon find out that it's difficult to live in the hospital being a doctor alone. Hmmm anyway I also commend good doctors you know. These men and women in uniforms and scrubs are the living heroes in our generation who are misinterpreted by many people because of some cases of negligence and death. I always admire nurses and doctors as well because they are doing something that normal persons cannot do.

I'm thanking you with tears rolling down my cheeks. This post is the best praise I ever received for my 47 years of nursing. I retired at 68-year-old, and now, at 80, I still miss patients and hospital life.

I'm a French Canadian and worked at many outposts, and in most hospital specialties in Ottawa and Toronto. But, in the mid-sixties, I had the great honour of working at the Houston Methodist Hospital, on Dr. Michael DeBakey's Cardiology Department. Nurses, on that floor, were interviewed and approved by Dr.DeBakey, and received a very serious training. I was able to watch the first open heart bypass surgeries performed by the great surgeon himself. It gave me such confidence and such pride in my chosen profession.

You're a great man, Dr.Grumpy. If I were still able to work, I would gladly apply at your hospital. I have met wonderful doctors everywhere but you have a great sensitivity for your patients and staff. I truly admire you. Thank you for your interesting and often amusing blog. I'm so glad I discovered you. I will print this post and offer it to my sons. It will give them an idea of the work their mother accomplished. May God bless you for all you do.

So good to see the responses here. For the record, I learnt neonatal intubation from the NICU nurse when I was an intern.It was a Medicine floor nurse who taught me how have my papers in order before a case presentation on rounds. And many other things. Many a times a saved a**Cant forget the "coffee and cake" in the wee hours that they shared with me on my night calls.God bless Dr. Grumpy for this post!

Dr G, a wonderful post. Nurses are indeed awesome. Towards the end of 2007 I had a heart attack. During the several weeks I was in hospital I received care that can only be described as exemplary. Some of the most *practical* advise on getting help to change the bad habits that brought the heart attack on in the first place were from nurses, of course.

Believe me, to all the nurses out there - you do a fantastic job under often difficult conditions. Be proud, and don't let the bloody admins get you down!

i don't know you, i came across your blog linked from a friend... as a nurse I just wanted to say "thanks" for recognizing our place in medicine and patient care. Thanks for your kind words and respect. We need more doctors like you. And your nurses are blessed to work with a doctor like you too.

Thank you for mentioning EMTs and medics, Grumpy. Too often we're glared at by ER doctors who don't bother to read our reports because "they know better," even though we may have spent 45 minutes with a patient.

During my last sojourn in hospital, one of the nurses appeared to be a little, well, 'old' for the job. She later told me that she was retired, but continued to volunteer her services free....just because!! I It takes a very special kind of person to be a nurse. Hats off to you all!!

Nurses are great...especially when you're screaming because the doc just stuck a 3 inch needle in your spine. I thought I crushed the lady's hand. But she was sweet as sugar (the doc too - he was my pain manager)

Don't forget the medical transcriptionists who have the knowledge to know when docs have dictated the incorrect medication, incorrect dosage, incorrect patient name or MR #...yet still they are being replaced by point and click. Unbelievable.

So many doctors don't get it.I work at a teaching hospital and back when I was getting my son diagnsosed for autism, I visited the peds clinic. The family practice resident came in to start his stuff. He recognized me from working my floor and he was just stupid. So when he said he had "experience" when autistics, I let my son loose on him. Fun to watch this guy try to chase my son around the room trying to listen to his heart and ask him questions when I told him he didn't talk. Now my son is more verbal and cooperative but I still don't think that doctor got it-don't be a smartass.As a night nurse, I feel for the residents we call. The hospital doesn't supply us with coffee and we buy our own and have become stingy with it. But they get coffee if they need it because both of us know we must look out for each other. Just don't ask us to make it for you. Ask how to work the coffeemaker.

Dr London was my internist. I have the signed copies to prove it. He was an absolute original, a sole practitioner who knew when to hold them, and when to refer them out, and when to tell very funny jokes. I don't know if he is deceased, but I do know that well in to his 70's he abruptly closed his practice and i have not heard of or from him, since. I miss him.

I'm a third-year resident in cardiothoracic surgery. I worked my way here -- I started out as an EMT, not sure if I wanted to do the whole medical thing, and I saw how people treated "just an EMT" and "just a medic."

Competent ER nurses have saved my ass at least a dozen times, and made me look good more times than I can count. And they do this for every EMT, every medic, every intern, every resident, every doctor.

I try to make sure when I work with a new nurse that he or she knows this. A competent nurse who knows that he or she is genuinely appreciated can move mountains, and a good surgical team or a good ER -- or even a good hospital -- succeeds or fails on the backs of its nurses.

I was hospitalized last November after a serious suicide attempt (28 grams of extended release Tylenol and anti-emetics). It was a horrible choice, and I wish I hadn't made it. I was on the med floor for 4 days hooked up to an IV.

On Thanksgiving Day, I had a nursing student sit with me. (I was given 1:1 observation.) His name was Mike and I still give thanks to him even today. Mike was so kind and helpful.

I love reading and learning, and so he let me read his nursing books and we studied together for his tests. I felt so grateful that he didn't look down on me for my mistakes.

Here it was Thanksgiving, and he could have been at home with his family. Instead, he was working at the hospital.

You can tell a lot about a person by how they treat nurses, waiters, janitors and secretaries. And it never hurts anyone to smile and be polite. It makes everyone's day just a little bit easier.

One of my cousins works as a nursing assistant at a small hospital, one of my friends cleans a mental healthcare facility- fun job. It's easy to forget that it takes a crew to keep a ship on track, not just a captain.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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